Learn to Swim Learn to Swim Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Parent name *FirstLastDate of birth *EG: 1/12/1999Address *Mobile number *Email address *How did you hear about us? *Select oneSocial mediaText MessageWebsiteGoogleLetterdrop FlyerWord of MouthCanberra Southern Cross Club ReferralEmail MarketingOthers – please specify belowIf you've selected 'Others', please specify how you heard about usWere you referred to us by someone? *Select oneYesNoIf you've been referred to us this Spring, both you and your friend will receive a $45 credit to use on future swimming lessons! Offer valid until 30 November 2024If 'yes', please provide your referrer's nameFirstLastEmergency contact name *Emergency contact relationship to you *Emergency contact number *Child 1 Full Name *FirstLastDate of birth (Child 1)EG: 1/12/1999What swimming experience does your child have? (Child 1) *EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…Child 2 Full NameFirstLastDate of birth (Child 2)EG: 1/12/1999What swimming experience does your child have? (Child 2)EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…Child 3 Full NameFirstLastDate of birth (Child 3)EG: 1/12/1999What swimming experience does your child have? (Child 3)EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…Child 4 Full NameFirstLastDate of birth (Child 4)EG: 1/12/1999What swimming experience does your child have? (Child 4)EG: Float on their back, Out their eyes in the water, Paddle, What strokes can they do…Submit
